MARCUS LOPEZ
Subscriber on policy B04M000012
Claims
1
Attributed to this person
Charged
879.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
131.85
Reported on the 835
Patient responsibility is the amount reported on the 835 as assigned to the patient — deductible, coinsurance or copay. It is not proof that the provider billed the member, that the member owes it, or that it was collected, and it is kept separate from denied amounts throughout.
Who this is
| Field | Value |
|---|---|
| Name | MARCUS LOPEZ |
| Role on the policy | Subscriber |
| Policy | B04M000012 |
| Date of birth | 1 Nov 1958 |
| Plan | SILVER HMO |
| Covered from | 30 Mar 2024 |
| Covered to | 1 Sep 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 131.85 |
| Total | 131.85 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000061 | 26 Jul 2024 | 879.00 | CASCADE CARE | Not denied | — |